NPIMap

Organization Active NPI

Sutter Coast Hospital

  • Rural Health Clinic/Center
  • Crescent City, CA
National Provider Identifier
1285641167
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SUTTER COAST HOSPITAL
Practice address
785 E. Washington Blvd.
Suite 10
Crescent City, CA 95531-8343
Phone
(707) 464-8818
Fax
(707) 464-8848
NPI assigned
Aug 2, 2006
Organization subpart
Yes
Parent organization
SUTTER COAST HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mitch Hanna
Title
Ceo
Phone
(707) 464-8880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X CA Primary

Addresses

Primary practice location

785 E. Washington Blvd.
Suite 10
Crescent City, CA 95531-8343

Mailing address

800 E. Washington Blvd
Crescent City, CA 95531-8359
Phone (707) 464-8511

Other identifiers 3

IdentifierTypeStateIssuer
RHM18519FMedicaidCA
177139MedicaidOR
HAP18519FOtherHAP

Other names 1

  • Sutter Coast Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111216000500 CA Part A Provider - Rural Health Clinic 9436148111 Practice locations: Crescent City, CA

Rural health clinic certification: CCN 058519

Legal name
SUTTER COAST HOSPITAL
Doing business as
SUTTER COAST HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 30, 1995
Last certification
Jul 24, 2015
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 23, 1985 in CA
Enrollment address
785 E Washington BLD, Ste 10
Crescent City, CA 95531-8372
Related CCNs
050417

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Sutter Urgent Care Clin5 organizations share this tax ID, including this one
Part of
Sutter Urgent Care Clin

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

555 5th St
Ste 2
Brookings, OR 97415
Phone (541) 469-9205

555 5th St
Brookings, OR 97415
Phone (541) 469-9205

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mitchell J Hanna Individual Corporate OfficerCeo Jun 24, 2014
Corporate DirectorBoard Member Jun 24, 2014
W-2 Managing EmployeeCeo/Administrator Jun 24, 2014
Patricia Piper Individual Corporate Director Nov 30, 2021
David G Itzen Individual Corporate DirectorBoard Member Oct 1, 2015
Clarke Moore Individual Corporate Director Nov 30, 2021
Ronald Sandler Individual Corporate Director Nov 30, 2021
Sutter Coast Hospital Organization, Crescent City, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 31, 1986 100%
Sutter Health Organization, Sacramento, CA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 31, 1986 100%
Timothy Noakes Individual Corporate Officer Oct 1, 2020
W-2 Managing Employee Oct 1, 2020

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 59

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 59

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1285641167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E. WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318359",
            "telephone_number": "707-464-8511",
            "fax_number": "707-464-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 E. WASHINGTON BLVD.",
            "address_2": "SUITE 10",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318343",
            "telephone_number": "707-464-8818",
            "fax_number": "707-464-8848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER COAST HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUTTER COAST HOSPITAL",
        "enumeration_date": "2006-08-02",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "HANNA",
        "authorized_official_first_name": "MITCH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-464-8880"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM18519F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177139",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "HAP18519F",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sutter Coast Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crescent City, CA

Sources for this page

Verify at the official NPI Registry.